NUTRITION DURING

LACTATION

zzt07

In-Hospital Breastfeeding Rates (US, 2001)

Healthy People 2010 Goal

Breastfeeding Rates at 6 mo (2001)

Healthy People 2010 Goal

Breastfeeding : A Learned Behavior

Physiological

process virtually all mothers

are capable of doing
Is a learned behavior not all mother
decide to do
Mothers partner also plays an important
role

Advantages
Nutritionally

superior to any alternatives

Bacteriologically safe & always fresh
Contains various antiinfectious factors &
immune cells
The least allergenic to any infant food

 Breast-fed

babies are less likely to be

overfed
Promotes good jaw & tooth development
Cost less
Promotes close mother-child contact
More convenient once the process is
established

American Academy of Pediatrics (AAP) &

American Dietetic Association (ADA)

Exclusive breastfeeding for 6 months,

and breastfeeding with
complementary foods for at least 12
months as an optimal feeding pattern
for infants

American Academy of Pediatrics (AAP)

Females infected with the human
immunodeficiency virus (HIV) should be
counseled not to beast-feed
Females who are at risk for being infected
with the virus should be educated about the
risk of infecting their infant with HIV
through breast milk

The Baby Friendly Hospital Initiative

effort to the incidence & duration
of breast-feeding
To become baby friendly, a hospital must
agree to implement the Ten steps to
Successful Breast-feeding
Global

Ten steps to successful breast-feeding

Have

a written breast-feeding policy that is

routinely communicated to all health care
staff
Train all health care staff in the skills
necessary to implement this policy
Inform all pregnant females about the
benefits and management of breast-feeding

 Help

the mother initiate breast-feeding

within a half hour of birth
Show mothers how to breast-feed and how
to maintain lactation, even if they are
separated from their infant
Give new born infants no food or drink other
than breast milk unless medically indicated

 Practice

rooming-in
Encourage breast-feeding on demand
Give no artificial teats or pacifiers
Foster the establishment of breast feeding
support groups, and refer mothers to them
on discharge from the hospital or clinic

Nutritional requirements
Lactation

is nutritionally demanding
Increased intake of most nutrient is advised
Milk production is most affected by the
frequency of suckling
Milk composition varies according to
mothers diet, but in general the effect is to
reduce quantity, not quality

Energy
Production

100 ml of milk need 85 kcal

expenditure
1st 6 mo of lactation 750 ml/day (550
1200 ml/day)
RDA : + 330 kcal (1st 6 mo)
+ 400 kcal (2nd 6 mo)

 2nd

6 mo
- production 600 ml/day
E req
- consuming solid food
Energy intake at least 1800 kcal/day
Inadeq maternal fluid intake affects milk
volume

 After

birth women are in a hurry to lose

weight
In general lose - 1 kg / mo during the
1st 4 6 mo of lactation
Exercise >> lactic acid of breast milk
influence milk taste

Breastfeeding and maternal weight loss

(Dewey et al. Am J Clin Nutr 1993;58:162-6)

Fat
20

35% of total calories

Presence of long-chain PUFA
(polyunsaturated fatty acid) crucial for
fetal & infant retina & brain development
AI n-6 PUFA : 13g/day
AI n-3 PUFA : 1.3 g/day

Human Milk Composition

Influences of maternal diet
a. CHO, protein & minerals not influenced by maternal diet
b. Fat and vitamins influenced by maternal diet

Human Milk Composition

Influences of maternal nutritional
status

- milk composition remains relatively constant unless

malnutrition
is severe
- the volume of milk produced may with malnutrition

Water
Drink a glass of milk, juice or water at
each meal and each time the infant
nurses

Nutrient supplements
Most

women can obtain all the nutrients

from a well balanced diet
Some may need iron to refill their
depleted iron stores

Particular foods
Foods

with strong or spicy flavors (e.g.

garlic) may alter the flavor of breast milk
Infants who develop symptoms of food
allergy more comfortable if the mothers
diet exclude the most common offenders
(cows milk, eggs, peanuts)

Increased Requirements

Practices incompatible with lactation

Alcohol

- easily enters breast milk

Smoking
- transfer nicotine
Medicinal drugs
Environmental contaminants
Caffeine

zzt07